Provider Demographics
NPI:1023075819
Name:MILLER, PAMELA DOVE (PAMELA MILLER,LMP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DOVE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PAMELA MILLER,LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21205 NE 10TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6732
Mailing Address - Country:US
Mailing Address - Phone:425-868-9795
Mailing Address - Fax:
Practice Address - Street 1:660 NW GILMAN BLVD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2421
Practice Address - Country:US
Practice Address - Phone:425-391-2380
Practice Address - Fax:425-391-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist